原发性肝癌手术前后营养风险筛查及临床分析-论文.pdf

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1、临床外科杂志2013年12月第21卷第l2期JClinSurg，December2013，Vo1．21，No．12·933··论著·原发性肝癌手术前后营养风险筛查及临床分析王代宏王芳元王伟刘志苏[摘要]目的探讨原发性肝癌患者手术前后营养风险筛查及联合肠内、肠外营养模式对临床结局的影响。方法参照NRS2002工具标准，36例患者住院后第1天进行营养风险筛查，评分t>3分给予营养支持，术前术后进行肠外肠内营养支持(研究组)。30例患者术前不进行任何营养评价，术后全部接受肠外肠内营养支持(对照组)，比较两组患者术后肝功能、凝血功能、白细胞计数、中性粒细胞比率及C反应蛋白指标的变化，同

2、时记录患者术后SIRS发生情况、感染性并发症的发生率及术后住院时间、住院费用。结果研究组患者术后第7天血清谷丙转氨酶(AST)及C反应蛋白明显低于对照组(P<0．05)，其余指标差异均无统计学意义(P>0．05)。研究组患者术后SIRS发生率、术后感染性并发症发生率及术后住院时间、住院费用明显低于对照组(P<0．05)。结论对于肝癌手术患者，入院时应进行营养风险筛查，有营养风险者，术前、术后联合营养支持有益于改善术后营养状况和缩短住院时间，减少医疗费用，改善临床结局。[关键词]肝癌；营养风险筛查；营养支持；临床结局[中图分类号]R735．7[文献标识码]A[DOI]10．396

3、9／j．issn．1005-6483．2013．12．017Pre-andpost-operativenutritionalriskscreeningandclinicalanalysisinpatientswithhepatocellu-larcarcinoma^Dai—hong，』、，G一yuan，，vG，eta1．(DepartmentofGeneralSurgery，XianningCentralHospital，Hubei437100，China)[Abstract]0bjectiveToexploretheeffectsofpre-andpost—operative

4、nutritionalriskscreening(NRS)andnutritionsupportoncliniealoutcomesinpatientswithhepatocellularcarcinoma．MethodsAccordingtotheNRS2002standard．theNRSscoringwasperformedatthefirstdayofhospitalization．Nu—tritionalriskWaSdefinedasNRS2002scores≥3．Patientswithnutritionalriskreceivedenteralnutrition

5、(EN)andparenteralnutrition(PN)supportpreoperativelyandpostoperatively．ThecontrolgroupreceivedENandPNsupportafteroperationwithoutNRS．Liverfunction．bloodcoagulationfunction．whitebloodcellcounts．percentageofneutrophilsandlevelsofserumC．reactiveprotein(CRP)weredetectedandcomparedbetweenthegroups

6、．Theincidenceofsystemicinflammatoryresponsesyndrome(SIRS)，infectiouscompli。cation．hospitalstayandtotalmedicalcostweremeasuredafteroperation．ResultsOnthe7thdayafteroperation，theserumlevelsofaspartatetrransaminase(AST)andCRPinthestudygroupweresignificantlylowerthanthoseinthecontrolgroup(P<0．05

7、)．Thoseotherindictionswerenotsignificantlydifferentbe．tweentwogroups(P>0．05)．TheincidenceofSIRSandinfectiouscomplication．hospitalstayandtotalmedicalcostinthestudygroupwassignificantlylowerthanthatinthecontrolgroup(P<0．05)．Conclu-sionForpatientswith